Children
Undertriage of Pediatric Major Trauma at a Spanish Pediatric Trauma Center: A 10-Year Retrospective Cohort Study
By Ana Abril-Molina, Laura Díaz-Rueda and Esther Ocete‐Hita.
Abstract
Background
Accurate field triage is a cornerstone of an inclusive trauma system, but pediatric undertriage remains poorly characterized outside North America. We aimed to estimate the rate of major trauma undertriage in a Spanish pediatric trauma center, to identify patient factors associated with it, and to explore its relationship with early clinical outcomes.
Methods
Retrospective cohort study (2016–2025) of children aged 0–14 years admitted to the pediatric intensive care unit (PICU) of the reference pediatric trauma center for the province of Granada, Spain. Major trauma was defined using a composite of the Cribari Matrix (ISS > 15) and/or the Need for Trauma Intervention (NFTI) criteria. Undertriage was defined as delayed (>2 h) or non-direct transport to the trauma center despite proximity (<30 min). The primary outcomes were the undertriage rate and the patient factors associated with it, examined by bivariate analysis and by Firth-penalized logistic regression with intercept correction (FLIC). Clinical outcomes (Glasgow Outcome Scale, PICU and total hospital length of stay) were prespecified as exploratory and analyzed with generalized linear models—binomial for binary outcomes and negative binomial for counts—and, as a sensitivity analysis, with targeted maximum likelihood estimation (TMLE).